Brachytherapy in Greater Poland Cancer Center
In Greater Poland Cancer Center (GCC) brachytherapy has been used to treat malignant tumors since early ‘50. Initially, the first line method of brachytherapy was treatment with radium. In ‘70. first LDR selectron, containing 137Cesium source, was bought, which enabled automated and safe usage of radioactive sources in gynecological malignances.
In ’90., after new modern equipment was bought - microSelectrons HDR and PDR – the number of treated patients increased significantly. Since that time the number of cancer types treated in GCC has been raised to the level which could be comparable to that of well known centers in European Union.
In 2006, the number of treated patients was estimated to be 1131, in 2007 - 1299, in 2008 - 1401, in 2009 - 1360, respectively, which made about 20% of all patients treated with radiotherapy in GCC. A new modern Brachytherapy Department, built in 2005, is located in a new wing of GCC.
Brachytherapy Department Structure:
- 2 bunkers devoted to HDR brachytherapy
- 1 bunker devoted to PDR brachytherapy
- operating theatre for applications done in local or general anaestesia
- Laboratory of Tumours Brachytherapy,
- Laboratory of Treatment Planning and Brachytherapeutic Dosimetry (under auspices of Medical Physics Department),
- Laboratory of Hyperthermia,
- Laboratory of Endoscopy,
- Laboratory of Permanent Implants,
- Out-patient Clinic,
- 2 wards (6 beds),
- duty-room,
- nurse’s station,
- secretaryship with office of the Head of the Department,
- archives.
Equipment:
Currently, there are 3 brachytherapy units in GCC:
1. Flexitron HDR I (High Dose Rate)
2. Flexitron HDR II (High Dose Rate)
3. microSelectron PDR (Pulsed Dose Rate)
The Department owns modern technology devices, such as:
- computer software for treatment planning - Oncentra Brachy
- CT scanner SOMATOM go.Open Pro
- a device for radiological verification (Siemens Cios Flow),
- 2 systems for real-time planning Oncentra Prostate for brachytherapy of prostate cancer,
- eye plaque brachytherapy planning system EyePhysics.
Modern HDR brachytherapy equipment enables concomitant insertion of needles to the prostate, treatment plan preparation and irradiation, all during one procedure. That’s why the system is called „real-time” planning.
Prostate cancer incidence is still increasing due to aging of society and, on the other hand, improvement in prostate cancer detection in its early stages. Because of these reasons the possibility of prostate cancer treatment with modern HDR technique has a significant influence on improvement in curability.
Permanent implants (radioactive sources of Iodine125 or Palladium103), placed in prostate for good, or HDR brachytherapy can be used in management of prostate cancer. The former method is used as a single and radical treatment modality and gradually replaces other treatment options for early prostate cancer. Brachytherapy with permanent radioactive seeds is currently the most frequently used technique in USA, much more frequent than total prostatectomy or external beam radiotherapy (EBRT). High cost of the seeds is a serious obstacle for introducing of this method in Poland. HDR brachytherapy is more popular in Europe and most often it is a part of treatment combined with EBRT. Additionally, HDR brachytherapy can be also administered in cases of local recurrences after previous irradiation or surgical treatment and as palliation.
Brachytherapy Department in GCC, as one of three centers in Poland, utilizes modern hyperthermia unit (BSD-400/500, BSD Medical) in treatment of selected group of patients. This type of treatment is equal to these of the best equipped centers of oncology in Europe.
Currently, GCC Brachytherapy Department offers as follows:
1. interstitial brachytherapy of prostate cancer (permanent implants I-125, HDR),
2. interstitial brachytherapy of breast cancer (HDR, PDR, Contura, SAVI),
3. interstitial brachytherapy of penile cancer,
4. interstitial brachytherapy of advanced abdominal malignancies, including pancreas, recurrences of colorectal cancer and retroperitoneal sarcomas,
5. interstitial brachytherapy of lip cancer,
6. interstitial and superficial brachytherapy of head & neck cancers,
7. interstitial and superficial brachytherapy of skin cancer,
8. endoluminal brachytherapy of tracheal and pulmonary cancers,
9. endoluminal brachytherapy of esophageal cancer,
10. endoluminal brachytherapy of bile duct cancer,
11. endoluminal and interstitial brachytherapy of anal cancer,
12. endoluminal and interstitial brachytherapy of gynecological cancers (in Department of Gynaecological Radiotherapy),
13. interstitial and superficial hyperthermia combined with brachytherapy, EBRT
14. diagnostic and therapeutic bronchoscopy.
Staff:
Brachytherapy procedures demands cooperation amongst a team of highly specialized medical workers. In GCC, brachytherapy is conducted by a team consisted of physicians (radiation oncologists), medical physicists, RTT's and nurses. Our personnel is trained in the best national and foreign centers.
Scientific research:
Over forty papers have been published by workers of the Department between 1999 and 2007. Over sixty conference presentations and lectures concerning brachytherapy were presented. The Head of the Department has completed his registration and conferment procedure for an assistant professor degree; another doctoral degrees are being conducted. All members of the Department take their active part in Polish and international scientific conferences annually.
The Department take its part in multicentric trials, e.g. phase III study (GEC-ESTRO APBI Trial) on the role of solitary brachytherapy in management of breast cancer or phase II study (PBIG Trial) on prostate cancer HDR monotherapy. The Department is also involved in numerous EU projects, e.g. EMPIRION or QUESTRO. In the Department, there are classes given to medical students, health sciences students and biotechnology students from the University of Medical Sciences in Poznan; and also to the physics students from universities of Poznan and Torun.
Cooperation:
Workers of GCC Brachytherapy Department gain and expand their experience in collaboration with other Polish and foreign centers, especially with brachyterapy departments in Bydgoszcz, Gliwice and Warsaw.
There was cooperation established with following institutions:
Institute of Oncology in Barcelona (Spain),
University of Erlangen (Geramany),
University of Vienna (Austria).
HDR/PDR brachytherapy of central nervous system tumors is applied in cooperation with the Clinic of Neurosurgery of the University of Medical Sciences (UMS) in Poznan; PDR brachytherapy of bile duct cancers – in cooperation with Municipal Hospital in Poznan; HDR/PDR brachytherapy of head & neck cancers – in cooperation with GCC Head & Neck Cancers Department and the Clinic of Otolaryngology and Laryngeal Oncology of UMS in Poznan.
Introducing new treatment methods:
Special and outstanding achievements of GCC Brachytherapy Department workers (first introduction of treatment methods in the region of Greater Poland) can be listed as follows:
1. Development of modern method of Pulsed Dose Rate brachytherapy in different types of malignant tumors; in GCC since 01-07-2000 (treatment conducted in 4 centers in Poland).
2. Development of HDR/PDR interstitial brachytherapy of central nervous system malignancies (in cooperation with the Clinic of Neurosurgery from UMS in Poznan).
3. Brachytherapy of coronary arteries restenoses (in cooperation with the Clinic of Cardiology from UMS in Poznan and Laboratory of Haemodynamics from the Struś Municipal Hospital in Poznan – the treatment used to be applied in 3 centers in Poland) and peripheral arteries restenoses (in cooperation with the Clinic of Vascular Surgery from UMS in Poznan).
4. Interstitial HDR brachytherapy of prostate cancer.
5. HDR/PDR brachytherapy of bile duct cancers (in cooperation with Municipal Hospital in Poznan – first in Poland routinely applied type treatment).
6. HDR/PDR brachytherapy of head & neck cancers (in cooperation with the Clinic of ENT and Laryngeal Oncology from UMS in Poznan.
7. HDR/PDR brachytherapy of breast cancer, also Contura as the first center outside the USA.
8. Permanent implants in prostate cancer brachytherapy.
Prof. Janusz Skowronek, MD, PhD,
Adam Chicheł, MD, PhD, Head of Brachytherapy Department